<p>The bottom line is that any doctors that are depending upon insurance company payments are being paid less and less for visits/procedures by the insurance companies and that will only get worse.</p>
<p>So specialists that are not paid by insurance companies because the procedures are not medically necessary, like plastic surgeons and dermatologists doing anti aging treatments, can charge what they want. Many top doctors do this in any type of medicine. But the typical doctors in most places do depend on their patients' insurance.</p>
<p>Radiology is prpbably the worst bet. Used to be very high paying, but now films are increasingly being read in India.</p>
<p>My understanding is that cardiologists are paid by the procedure. Your earnings depend on how many customers you are able to perform your procedures on....correct?? I doubt that many active cardiologists are on "salary".</p>
<p>"newmassdad, many, many people are and will continue to be willing to pay for beauty."</p>
<p>Oh, really now. I have no idea what you mean by "many, many", but, in lookingat this comment and at your other post about radiologists, I think you are reacting a bit too much to what is written in the popular media. But that's OK. Hopefully, in college you'll learn a bit more about critical reading and so forth (sorry if this sounds condescending - I apologize in advance). This is an interesting arena, where a lot of fluff is being passed around. </p>
<p>I won't bore you with any economics lessons. Suffice to say that the percentage of docs who can tap into the elective procedure gravy train (mostly plastic surgeons and dermatologists) is relatively small. After all, how many folks do you know who have an extra 5-25,000 lying around to spend on vanity? Since this trend started from a small base, the increases, in percent, are impressive. Relative to overall doc payments, the amount is small.</p>
<p>Dadx, many specialists are, in fact, paid by procedure. But, the allowable amount continues to be squeezed. In addition, there is constant pressure to move services to different, often lower cost, settings. For instance, interventional cardiology initially took off because it offered a way for a cardiologist to capture the revenue that was previously lost in a referral to a cardiac surgeon.</p>
<p>
[quote]
I doubt that many active cardiologists are on "salary".
[/quote]
Our local pediatric cardiology practice is an academic one, meaning that they are on salary, paid by the local med school/foundation. They do some invasive procedures, but are less procedure-oriented than adult cardiologists.</p>
<p>If the OP is looking for a big salary in the medical field, how about being an insurance exec? According to an article in last week's paper, the local Blue Cross/Blue Shield provider pays very well indeed:</p>
<p>3 execs w/compensation of more than $1M per year; another 53 are paid $200K or more yearly. The salary table printed in the local paper isn't included in the link above, but it made for some interesting breakfast table conversation. The adviser to the CEO makes $963K per year; senior vice presidents make $400K-plus per year, and the lowest paid exec, a mere VP, gets $200K annually. (This happens to be more than the pediatric cardiologists make or have any hope of making in the future.) </p>
<p>And this is a nonprofit insurance provider. As it happens to be our family's insurance provider, I can tell you that not enough money is spent on training/compensating customer service reps, because the service is execrable.</p>
<p>Newmassdad, feel free to bore me with the economics. Undergrad economics major and Harvard MBA here. As a management consultant, I did extensive work for medical organizations. </p>
<p>There is pleanty of money in medicine if you are good and do your homework. Plastic surgery? It's booming and will continue to as boomers continue to seek the fountain of youth and less invasive procedures become available. While some patients do have the money just lying around, many are willing to go into debt for vanity. That's just the start. Cardiologists, oncologists, endrocronoligists and many other specialists will do incredibly well if they are good and well located. Many top doctors do not deal with insurance companies. Their patients pay cash and get what they can from their insurers. Saving the lives of those they love is a place where many don't scrimp.</p>
<p>The information is all out there as to who in the industry will suffer. We warned that radiologists were in trouble a decade ago. Don't get me wrong, many in the medical profession will suffer. But not those who are good, mobile and have done their homework.</p>
<p>What I particularly don't understand is how all of the doctors who live around me are so well off. I live in a very wealthy NY suburb and many of my friends' parents are doctors. Pediatricians, cardiologists, dermotologists, you name it. They're all living in 1.5mil houses and their kids are driving BMWs. Whats up with that? Not to mention the orthapedic surgeons, they seem to be making a killing too. Are all of these doctors just charging their patients cash?</p>
<p>Eevn when I used to go to my own pediatrician's office, where 5 or so pediatricians worked together, the parking lot was littered with mercedes and audis with MD plates. How are they doing so well?</p>
<p>Don't pick a career based upon salary...pick a career that you will wake up every day enthusiatic about, so you can look forward to Monday mornings.</p>
<p>There are a lot of ways for doctors to make money other than seeing patients and doing procedures. Doctors often invest in equipment and then rent it to other doctors. They invest in clinics of all sorts such as sports medicine clinics.</p>
<p>At a recent AMA dinner, the talk was about the increasing number of MDs who are also getting MBAs.</p>
<p>Yes, I was bowled over a few weeks ago when I took my son to the dermatologist his pediatrician recommended. I thought I had entered a spa by mistake. There were mulitple technicians doing all sorts of skin treatments on women of all ages. Microdermabrasion looks like it hurts! So while there were a few other broken out teens, there were scores of women there for botox, etc. </p>
<p>In the waiting room were books filled with before and after pictures. Stunning! The receptionist saw me looking and asked if I wanted a consultation. Why the heck not? Soon I was ushered to a beautiful room with soft music by a 40 plus year old with flawless skin. She ran down everything that could, um, be of help to me! Sold!! There were procedures for $300 and ones for $5000. Think I'll start slow.</p>
<p>That one doctor probably had 5000 sq. ft. and 15 employees. I'm sure he'll soon franchise!</p>
<p>Since most people seem to be preaching about how you shouldn't ask about the salary, I'll answer the question. I know that this may not be your only incentive for doing this, just the one you aren't sure about.</p>
<p>The base salary for an invasive Cardiologist mid 50th percentile is $263566 according to salary.com.</p>
<p>Cardiologists make an excellent living, particularily if they establish private practice. All the cardiologists I know have incomes in the top 1% of the US (above $460K).</p>
<p>However, a cardiologist, especially a good cardiologist, is dedicated beyond belief. They work 14 hour days, age 40 and beyond, they wake at 4 am to check on hospital patients at 5 am to get into the office by 8. They never know which important occasion will be interrupted by an emergency. </p>
<p>Speaking to the "spa-ization" of medical care...in Asia there is now a trend towards, "Medical Tourism". People come to Singapore and Thailand (in particular) for elective medical procedures (sometimes plastic surgery, but also Orthopedics) at much lower cost than a comparable procedure in the US. They tack on a holiday at one end or another.</p>
<p>As for the 5000 square foot medical offices this has really taken off in Singapore. The lobbies (not waiting rooms) are equipped with fine replica furniture, you are offered a cappucino while you wait, etc..The one thing is that "lifestyle" procedures can't be taking place (by law) in the same office as "medical" procedures. So, the crafty way to get around it is that the offices are adjacent, separate entrances. You go in one entrance for your massage or spa treatments, another for your liposuction or botox. Not only the dermatologists and cosmetic or plastic surgeons have this going on. Virtually every type of doctor has a potential for "lifestyle" enhancement as an adjunct to their medical care.</p>
<p>Wave of the future. Goodby to the cottage practice of medicine forever?</p>
<p>"Harvard MBA here. As a management consultant, I did extensive work for medical organizations."</p>
<p>Ah, that explains it. Never did meet a Harvard MBA who could run a good spreadsheet. They're great at management meetings, however. Now a Chicago grad... :-)</p>
<p>Zagat, the problem you and others have is that you are backward looking. Your choice of words (nice, subjective ones like "many") looks like a smokescreen for real data. Anyway, for every Scarsdale doc who gets lots of insurance-free dollars from the local matrons, there's many more down in the Bronx, Upstate NY (been to Buffalo lately????) or many other places just trying to avoid the squeeze between declining reimbursements from insured patients, declining numbers of insured patients (seen those numbers recently? Not pretty) and Medicare/Medicaid, which have their own fee squeezes. I bet you've not consulted with any organizations supporting those poor folks.</p>
<p>For all of you that see the MD plated beemers parked locally, I suggest you keep in mind that most neighborhoods are not like that, not that I expect posters of privilege here to ever see these worlds.</p>
<p>People can always say that not all doctors are rich, but I've never seen a doctor with financial problems. Besides, it would be dumb if that was the only reason to become one.</p>
<p>Something to watch out for is the long-run possibility that a given area could be affected by technology changes. If, for example, a plaque-reducing drug was developed, it could quite significantly affect the business of cardiology. No such breakthrough is imminent, but in terms of planning a couple of decades down the road, who knows?</p>
<p>That's not to say that cardiologists will go out of business; dentists, by and large, have adapted ot much lower rates of cavities (their previous bread-and-butter).</p>
<p>funny you should mention scarsdale as I live about two towns away. I understand that not all doctors are as wealthy as the ones with the BMWs, but I still don't understand why THOSE doctors are wealthy. They're pediatricians, they share a practice, they're not importing clients from Canada... so why are they so well off? I'm not trying to sound jaded, I just don't really get it. And it's not like they're hte only ones, I know very many of my friends' parents who are exactly the same.</p>
<p>The reason some docs of same specialty do better than others is complex, but is greatly influenced by how they are paid.</p>
<p>In addition to the declining percentage of the workforce having any kind of health insurance at all, those that do have insurance have been increasingly pushed into what is called managed care. In practice, payment schemes fall into a few categories. For primary care docs, capitation is common - they get a fixed fee per month per patient. Many other payment systems rely on discounted fee models, where a doc agrees to a sharply reduced payment in return for being part of the referral network.</p>
<p>In the "good old days" coverage was handled by indemnity insurance, where a doc was paid whatever he billed, up to a nonpublished limit. You still see this in some plans that allow out of network visits, but beware the term "reasonable and customary" which establishes a secret (secret because the insurer will never tell you) limit on what they will pay for each procedure.</p>
<p>What does this mean for Scarsdale like communities? As you go up the pay ranks, you are increasingly likely to be given more generous forms of health care insurance, like first dollar (no deductibles) indemnity insurance with no r&c limits, broad coverage of elective treatments etc. So docs with many of these patients can have much higher income.</p>
<p>There are other ways to a higher income, of course, such as being the senior partner in a successful group practice, but nothing leads to higher income if you are in the wrong place. If you are in a community with a lot of uninsured, lousy insurance coverage, etc, you gots a problem. Like in real estate, location, location...</p>
<p>First day of medical school, dean giving the opening address to all us new arrivers...the only line I remember is:</p>
<p>"Make sure to buy your BMW, Mercedes or whatever, new or used, before you arrive in a new town so no one will think you made the money off of them."</p>
<p>Among other pieces of ridiculous advice, this seemed the least helpful.</p>
<p>Attention Newmassdad, the wonderful Harvard MBA.</p>
<p>"The reason some docs of same specialty do better than others is complex, but is greatly influenced by how they are paid."</p>
<p>It's not that complex, surgeons are paid better than regular doctors because they have to work longer hours and do more difficult things. Different specialties get different pay based on the difficulty and the number of cases that come in for treatment in their field. Some doctors also do better than others because they are more financially smart.</p>
<p>If only it were as simple as you suggest, although your last comment certainly has merit.</p>
<p>Keep in mind, too, that I've been commenting on where doc income is going, not where it's been.</p>
<p>From an economic point of view, heath care is a curious example of market failure. Consider:</p>
<ul>
<li><p>Unlike most other market settings, the consumer is normally not the payer. (when they are, they often go bankrupt, but that's another topic.) </p></li>
<li><p>Unlike other markets, increased supply (=more docs) seems to raise consumption and have no effect on prices.</p></li>
</ul>
<p>For these reasons, explanations like texasmathwhiz's don't wash well.</p>